A bladder injury often occurs when the pelvis is injured, as in a high-speed motor vehicle crash or a fall. Penetrating wounds, usually resulting from gunshots, can rarely injure the bladder. In addition, a bladder injury may occur unintentionally during surgery involving the lower abdomen or pelvis (such as removal of the uterus [hysterectomy], cesarean delivery, or removal of the colon [colectomy]).
If bladder injuries are not promptly treated, complications such as the following may develop:
The most common symptoms of a bladder injury are visible blood in the urine, difficulty in urinating, and pain in the pelvis and lower abdomen or during urination. If the lowermost portion of the bladder (where the muscle that helps to control urination is located) has been injured, the person may experience frequent urination or urinary incontinence.
The diagnosis of a bladder injury is best established by cystography, a procedure in which a radiopaque contrast agent, a liquid that is visible on x-rays, is injected into the bladder and CT or standard x-rays are used to look for leakage (see Imaging Tests of the Urinary Tract). Bladder injuries that occur during a surgical procedure are usually recognized promptly at the time of surgery and imaging tests of the bladder are not needed.
Minor bladder injuries, either bruises or select small tears (lacerations), may be treated by inserting a catheter into the urethra for 5 to 10 days. The catheter continuously drains urine so the bladder does not fill up, which makes it easier for the bladder to heal.
For more extensive bladder injuries or any injury resulting in leakage of urine into the abdominal cavity, surgery should be done to determine the extent of the injury and to repair all tears. The urine can then be more effectively drained from the bladder using one or, rarely, two catheters. The catheters are inserted through the urethra (a transurethral catheter) and/or directly into the bladder through the skin over the lower abdomen (a suprapubic catheter). These catheters are removed in 7 to 10 days or once the bladder has healed satisfactorily. If complications develop, they must be treated.
When a bladder injury is recognized during a surgical procedure, it should be treated at that time.